Recently I stumbled across a very good tutorial on how to Parse CCDs in Mirth using MDHT (Model Driven Health Tools). This tutorial will help you setting up the Mirth to use MDHT lib. http://www.spheregen.com/parsing-continuity-of-care-ccd-using-mirth-and-mdht/
It was such an easy to implement the tutorial that it inspired me to do a POC with MDHT & Mirth and I thought of converting Consolidated CDA documents to json.
Then I searched if this is already implemented and found two very useful open source libraries.
I tried bluebutton.js first and it was really easy to implement with javascript in browser that I just copied the json format from it.
After successfully converting C-CDA to json using MDHT in Mirth, I then thought of going a step ahead and storing this json in MongoDB with same Mirth Channel and see how Mongo queries can be used to do analytics from document repository created out of it.
Here is how the high level architecture of this POC looks like
Mirth Channel Details
- This Mirth channel is configured to listen as a File Reader for incoming C-CDA XMLs
- Once XML is received, channel creates CDA Document using MDHT toolkit )tutorial link shared at beginning of this article)
- Source Transformer converts each section to json and stores it in ChannelMap
- Channel Destination is configured as Javascript Writer
- Destination has a custom code to write the json to MongoDB
- JSON data stored in MongoDB can be used for analytics with Mongo Queries
- Patient/document matching (duplicate check) is not handled in this POC
- Pre-requisite for using MongoDB in Mirth is to copy java driver jar file in Mirth's custom-lib folder.
Mirth connect transformer step to convert Allergy Section XML to json using MDHT
var document = {}
// parse CCDA header - header parsing code removed from sample code
//Allergies Section - Only Allergy Section parsing is included in sample code
var allergiesSection = doc.getAllergiesSection();
if(allergiesSection!= null && ! allergiesSection.getAllergyProblemActs().isEmpty() )
{
var allergyData = [];
var sizeAllergyProblemActs = allergiesSection.getAllergyProblemActs().size();
for(i=0; i < sizeAllergyProblemActs; i++)
{
var allergyJson = {};
var alrgProbAct = allergiesSection.getAllergyProblemActs().get(i);
allergyJson.effectiveTime = parseDate(alrgProbAct.getEffectiveTime());
if(! alrgProbAct.getEntryRelationships().isEmpty() )
{
var sizeAlrgEntryRelationships = alrgProbAct.getEntryRelationships().size();
for(j=0; j < sizeAlrgEntryRelationships; j++)
{
var obs = alrgProbAct.getEntryRelationships().get(j).getObservation();
var templateId = obs.getTemplateIds().get(j).getRoot();
if(templateId == "2.16.840.1.113883.10.20.22.4.7")
{
allergyJson.code = new String( obs.getCode().getCode() );
allergyJson.code = new String( obs.getCode().getDisplayName() );
allergyJson.code = new String( obs.getCode().getCodeSystem() );
allergyJson.code = new String( obs.getCode().getCodeSystemName() );
if(! obs.getValues().isEmpty() && obs.getValues().get(0) instanceof org.openhealthtools.mdht.uml.hl7.datatypes.CD)
{
var cd = org.openhealthtools.mdht.uml.hl7.datatypes.CD ( obs.getValues().get(0) );
allergyJson.reaction_type_name = new String( cd.getDisplayName() );
allergyJson.reaction_type_code = new String( cd.getCode() );
allergyJson.reaction_type_code_system = new String( cd.getCodeSystem() );
allergyJson.reaction_type_code_system_name = new String( cd.getCodeSystemName() );
}
}
if(! obs.getEntryRelationships().isEmpty() )
{
sizeAlrgObsEntryRel = obs.getEntryRelationships().size();
for(k=0; k < sizeAlrgObsEntryRel; k++)
{
var obsEntryRelObs = obs.getEntryRelationships().get(k).getObservation();
var obsEntryRelObsTemplateId = obsEntryRelObs.getTemplateIds().get(0).getRoot();
if(obsEntryRelObsTemplateId == "2.16.840.1.113883.10.20.22.4.28")
{
if(! obsEntryRelObs.getValues().isEmpty() && obsEntryRelObs.getValues().get(0) instanceof org.openhealthtools.mdht.uml.hl7.datatypes.CD)
{
var cd = org.openhealthtools.mdht.uml.hl7.datatypes.CD ( obsEntryRelObs.getValues().get(0) );
allergyJson.status = new String( cd.getDisplayName() );
}
}
else if(obsEntryRelObsTemplateId == "2.16.840.1.113883.10.20.22.4.9")
{
if(! obsEntryRelObs.getValues().isEmpty() && obsEntryRelObs.getValues().get(0) instanceof org.openhealthtools.mdht.uml.hl7.datatypes.CD)
{
var cd = org.openhealthtools.mdht.uml.hl7.datatypes.CD ( obsEntryRelObs.getValues().get(0) );
allergyJson.reaction_name = new String( cd.getDisplayName() );
allergyJson.reaction_code = new String( cd.getCode() );
allergyJson.reaction_code_system = new String( cd.getCodeSystem() );
}
}
else if(obsEntryRelObsTemplateId == "2.16.840.1.113883.10.20.22.4.8")
{
if(! obsEntryRelObs.getValues().isEmpty() && obsEntryRelObs.getValues().get(0) instanceof org.openhealthtools.mdht.uml.hl7.datatypes.CD)
{
var cd = org.openhealthtools.mdht.uml.hl7.datatypes.CD ( obsEntryRelObs.getValues().get(0) );
allergyJson.severity = new String( cd.getDisplayName() );
}
}
}
}
if(! obs.getParticipants().isEmpty() )
{
allergyJson.allergen_name = new String( obs.getParticipants().get(0).getParticipantRole().getPlayingEntity().getCode().getDisplayName() );
allergyJson.allergen_code = new String( obs.getParticipants().get(0).getParticipantRole().getPlayingEntity().getCode().getCode() );
allergyJson.allergen_code_system = new String( obs.getParticipants().get(0).getParticipantRole().getPlayingEntity().getCode().getCodeSystem() );
allergyJson.allergen_code_system_name = new String( obs.getParticipants().get(0).getParticipantRole().getPlayingEntity().getCode().getCodeSystemName() );
if(!obs.getParticipants().get(0).getParticipantRole().getPlayingEntity().getNames().isEmpty() )
{
allergyJson.allergen_name = new String( obs.getParticipants().get(0).getParticipantRole().getPlayingEntity().getNames().get(0).getText() );
}
}
}
}
allergyData.push(allergyJson);
}
document.allergies = allergyData;
var objAllergy = JSON.stringify(allergyData);
channelMap.put('objAllergy',objAllergy);
}
Sample CCDA document XML
<?xml version="1.0"?>
<?xml-stylesheet type="text/xsl" href="CDA.xsl"?>
<!--
Title: US_Realm_Header_Template
Original Filename: US_Realm_Header_Template.xml
Version: 1.0
Revision History:
01/31/2011 bam created
07/29/2011 RWM modified
-->
<ClinicalDocument xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
xsi:schemaLocation="urn:hl7-org:v3 http://xreg2.nist.gov:8080/hitspValidation/schema/cdar2c32/infrastructure/cda/C32_CDA.xsd"
xmlns="urn:hl7-org:v3"
xmlns:mif="urn:hl7-org:v3/mif">
<!--
********************************************************
CDA Header
********************************************************
-->
<realmCode code="US"/>
<typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
<!-- US General Header Template -->
<templateId root="2.16.840.1.113883.10.20.22.1.1"/>
<!-- *** Note: The next templateId, code and title will differ depending on what type of document is being sent. *** -->
<!-- conforms to the document specific requirements -->
<templateId root="2.16.840.1.113883.10.20.22.1.2"/>
<id extension="999021" root="2.16.840.1.113883.19"/>
<code codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" code="34133-9" displayName="Summarization of Episode Note"/>
<title>Good Health Health Summary</title>
<effectiveTime value="20050329171504+0500"/>
<confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
<languageCode code="en-US"/>
<setId extension="111199021" root="2.16.840.1.113883.19"/>
<versionNumber value="1"/>
<recordTarget>
<patientRole>
<id extension="12345" root="2.16.840.1.113883.19"/>
<!-- Fake ID using HL7 example OID. -->
<id extension="111-00-1234" root="2.16.840.1.113883.4.1"/>
<!-- Fake Social Security Number using the actual SSN OID. -->
<addr use="HP">
<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
<streetAddressLine>17 Daws Rd.</streetAddressLine>
<city>Blue Bell</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>US</country>
<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
</addr>
<telecom value="tel:(781)555-1212" use="HP"/>
<!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
<patient>
<name use="L">
<!-- L is "Legal" from HL7 EntityNameUse 2.16.840.1.113883.5.45 -->
<prefix>Mr.</prefix>
<given>Adam1</given>
<given qualifier="CL">Frankie</given>
<!-- CL is "Call me" from HL7 EntityNamePartQualifier 2.16.840.1.113883.5.43 -->
<family>Everyman</family>
</name>
<administrativeGenderCode code="M" codeSystem="2.16.840.1.113883.5.1" displayName="Male"/>
<birthTime value="19541125"/>
<maritalStatusCode code="M" displayName="Married" codeSystem="2.16.840.1.113883.5.2" codeSystemName="MaritalStatusCode"/>
<religiousAffiliationCode code="1013" displayName="Christian (non-Catholic, non-specific)" codeSystemName="HL7 Religious Affiliation " codeSystem="2.16.840.1.113883.1.11.19185"/>
<raceCode code="2106-3" displayName="White" codeSystem="2.16.840.1.113883.6.238" codeSystemName="Race and Ethnicity - CDC"/>
<ethnicGroupCode code="2186-5" displayName="Not Hispanic or Latino" codeSystem="2.16.840.1.113883.6.238" codeSystemName="Race and Ethnicity - CDC"/>
<guardian>
<code code="GRFTH" displayName="Grandfather" codeSystem="2.16.840.1.113883.5.111" codeSystemName="HL7 Role code"/>
<addr use="HP">
<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
<streetAddressLine>17 Daws Rd.</streetAddressLine>
<city>Blue Bell</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>US</country>
<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
</addr>
<telecom value="tel:(781)555-1212" use="HP"/>
<guardianPerson>
<name>
<given>Ralph</given>
<family>Relative</family>
</name>
</guardianPerson>
</guardian>
<birthplace>
<place>
<addr>
<state>MA</state>
<postalCode>02368</postalCode>
<country>USA</country>
</addr>
</place>
</birthplace>
<languageCommunication>
<languageCode code="fr-CN"/>
<modeCode code="RWR" displayName="Recieve Written" codeSystem="2.16.840.1.113883.5.60" codeSystemName="LanguageAbilityMode"/>
<preferenceInd value="true"/>
</languageCommunication>
</patient>
<providerOrganization>
<id root="2.16.840.1.113883.19"/>
<name>Good Health Clinic</name>
<telecom use="WP" value="tel:(781)555-1212"/>
<addr>
<streetAddressLine>21 North Ave</streetAddressLine>
<city>Burlington</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>USA</country>
</addr>
</providerOrganization>
</patientRole>
</recordTarget>
<author>
<time value="20050329224411+0500"/>
<assignedAuthor>
<id extension="KP00017" root="2.16.840.1.113883.19.5"/>
<addr>
<streetAddressLine>21 North Ave.</streetAddressLine>
<city>Burlington</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>USA</country>
</addr>
<telecom use="WP" value="tel:(555)555-1003"/>
<assignedPerson>
<name>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
</assignedAuthor>
</author>
<dataEnterer>
<assignedEntity>
<id root="2.16.840.1.113883.19.5" extension="43252"/>
<addr>
<streetAddressLine>21 North Ave.</streetAddressLine>
<city>Burlington</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>USA</country>
</addr>
<telecom use="WP" value="tel:(555)555-1003"/>
<assignedPerson>
<name>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
</assignedEntity>
</dataEnterer>
<informant>
<assignedEntity>
<id extension="KP00017" root="2.16.840.1.113883.19.5"/>
<addr>
<streetAddressLine>21 North Ave.</streetAddressLine>
<city>Burlington</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>USA</country>
</addr>
<telecom value="tel:(555)555-1003"/>
<assignedPerson>
<name>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
</assignedEntity>
</informant>
<informant>
<relatedEntity classCode="PRS">
<!-- classCode PRS represents a person with personal relationship with the patient. -->
<code code="SPS" displayName="SPOUSE" codeSystem="2.16.840.1.113883.1.11.19563" codeSystemName="Personal Relationship Role Type Value Set"/>
<relatedPerson>
<name>
<given>Rose</given>
<family>Everyman</family>
</name>
</relatedPerson>
</relatedEntity>
</informant>
<custodian>
<assignedCustodian>
<representedCustodianOrganization>
<id root="2.16.840.1.113883.19.5"/>
<name>Good Health Clinic</name>
<telecom value="tel:(555)555-1212" use="WP"/>
<addr use="WP">
<streetAddressLine>17 Daws Rd.</streetAddressLine>
<city>Blue Bell</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>USA</country>
</addr>
</representedCustodianOrganization>
</assignedCustodian>
</custodian>
<informationRecipient>
<intendedRecipient>
<informationRecipient>
<name>
<given>Henry</given>
<family>Seven</family>
</name>
</informationRecipient>
<receivedOrganization>
<name>Good Health Clinic</name>
</receivedOrganization>
</intendedRecipient>
</informationRecipient>
<legalAuthenticator>
<time value="20050329224411+0500"/>
<signatureCode code="S"/>
<assignedEntity>
<id extension="KP00017" root="2.16.840.1.113883.19"/>
<addr>
<streetAddressLine>21 North Ave.</streetAddressLine>
<city>Burlington</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>USA</country>
</addr>
<telecom use="WP" value="tel:(555)555-1003"/>
<assignedPerson>
<name>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
</assignedEntity>
</legalAuthenticator>
<authenticator>
<time value="20050329224411+0500"/>
<signatureCode code="S"/>
<assignedEntity>
<id extension="KP00017" root="2.16.840.1.113883.19"/>
<addr>
<streetAddressLine>21 North Ave.</streetAddressLine>
<city>Burlington</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>USA</country>
</addr>
<telecom use="WP" value="tel:(555)555-1003"/>
<assignedPerson>
<name>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
</assignedEntity>
</authenticator>
<documentationOf typeCode="DOC">
<serviceEvent classCode="PCPR">
<effectiveTime>
<low value="20100601"/>
<high value="20100915"/>
</effectiveTime>
<performer typeCode="PRF">
<functionCode code="PP" displayName="Primary Care Provider" codeSystem="2.16.840.1.113883.12.443" codeSystemName="Provider Role">
<originalText>Primary Care Provider</originalText>
</functionCode>
<time>
<low value="20020716"/>
<high value="20070915"/>
</time>
<assignedEntity>
<id extension="PseudoMD-1" root="2.16.840.1.113883.19"/>
<code code="200000000X" displayName="Allopathic and Osteopathic Physicians" codeSystemName="Provider Codes" codeSystem="2.16.840.1.113883.6.101"/>
<addr/>
<telecom value="tel:+1-301-975-3251" use="HP"/>
<assignedPerson>
<name>
<prefix>Dr.</prefix>
<given>Pseudo</given>
<family>Physician-1</family>
</name>
</assignedPerson>
<representedOrganization>
<id root="2.16.840.1.113883.3.72.5"/>
<name>NIST HL7 Test Laboratory</name>
<telecom/>
<addr/>
</representedOrganization>
</assignedEntity>
</performer>
<performer typeCode="PPRF">
<functionCode code="PP" displayName="Primary Care Provider" codeSystem="2.16.840.1.113883.12.443" codeSystemName="Provider Role">
<originalText>Primary Care Provider</originalText>
</functionCode>
<time>
<low value="20020716"/>
<high value="20070915"/>
</time>
<assignedEntity>
<id extension="PseudoMD-3" root="2.16.840.1.113883.19"/>
<code code="207RG0100X" displayName="Gastroenterologist" codeSystemName="Provider Codes" codeSystem="2.16.840.1.113883.6.101"/>
<addr/>
<telecom value="tel:+1-301-975-3251" use="HP"/>
<assignedPerson>
<name>
<prefix>Dr.</prefix>
<given>Pseudo</given>
<family>Physician-3</family>
</name>
</assignedPerson>
<representedOrganization>
<id root="2.16.840.1.113883.19.123"/>
<name>HL7 Test Laboratory</name>
<telecom/>
<addr/>
</representedOrganization>
</assignedEntity>
</performer>
</serviceEvent>
</documentationOf>
<!-- ********************************************************
CDA Body
******************************************************** -->
<component>
<structuredBody>
<!-- *********************** -->
<!--
********************************************************
Allergies, Adverse Reactions, Alerts
********************************************************
-->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.6.1"/>
<!-- Alerts section template -->
<code code="48765-2" codeSystem="2.16.840.1.113883.6.1"/>
<title>Allergies, Adverse Reactions, Alerts</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Substance</th>
<th>Reaction</th>
<th>Status</th>
</tr>
</thead>
<tbody>
<tr>
<td>Penicillin</td>
<td>
<content ID="reaction1">Hives</content>
</td>
<td>Active</td>
</tr>
<tr>
<td>Aspirin</td>
<td>
<content ID="reaction2">Wheezing</content>
</td>
<td>Active</td>
</tr>
<tr>
<td>Codeine</td>
<td>
<content ID="reaction3">Nausea</content>
</td>
<td>Active</td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.30"/>
<!-- ** Allergy problem act ** -->
<id root="36e3e930-7b14-11db-9fe1-0800200c9a66"/>
<code code="48765-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Allergies, adverse reactions, alerts"/>
<statusCode code="active"/>
<effectiveTime value="20090909">
<low value="20090902"/>
<high value="20100103"/>
</effectiveTime>
<entryRelationship typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN">
<!-- allergy observation template -->
<templateId root="2.16.840.1.113883.10.20.22.4.7"/>
<id root="4adc1020-7b14-11db-9fe1-0800200c9a66"/>
<code code="416098002" displayName="drug allergy" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20110215"/>
</effectiveTime>
<value xsi:type="CD" code="282100009" displayName="Adverse reaction to substance" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT">
<originalText>
<reference value="#reaction1"/>
</originalText>
</value>
<participant typeCode="CSM">
<participantRole classCode="MANU">
<playingEntity classCode="MMAT">
<code code="314422" displayName="ALLERGENIC EXTRACT, PENICILLIN" codeSystem="2.16.840.1.113883.6.88" codeSystemName="RxNorm">
<originalText>
<reference value="#reaction1"/>
</originalText>
</code>
<name>Penicillin</name>
</playingEntity>
</participantRole>
</participant>
<entryRelationship typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.28"/>
<!-- Alert status observation template -->
<code code="33999-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Status"/>
<statusCode code="completed"/>
<value xsi:type="CE" code="55561003" codeSystem="2.16.840.1.113883.6.96" displayName="Active"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="MFST">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.9"/>
<!-- Reaction observation template -->
<id root="4adc1020-7b14-11db-9fe1-0800200c9a64"/>
<code nullFlavor="NA"/>
<text>
<reference value="#reaction1"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value="20090711"/>
</effectiveTime>
<value xsi:type="CD" code="247472004" codeSystem="2.16.840.1.113883.6.96" displayName="Hives"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.8"/>
<!-- ** Severity observation template ** -->
<code code="SEV" displayName="Severity Observation" codeSystem="2.16.840.1.113883.5.4" codeSystemName="ActCode"/>
<text>
<reference value="#severity1"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" code="371924009" displayName="Moderate to severe" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"/>
</observation>
</entryRelationship>
</observation>
</entryRelationship>
</act>
</entry>
<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.30"/>
<!-- ** Allergy problem act ** -->
<id root="36e3e930-7b14-11db-9fe1-0800200c9a66"/>
<code code="48765-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Allergies, adverse reactions, alerts"/>
<statusCode code="active"/>
<effectiveTime value="20090909">
<low value="20090902"/>
<high value="20100103"/>
</effectiveTime>
<entryRelationship typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN">
<!-- allergy observation template -->
<templateId root="2.16.840.1.113883.10.20.22.4.7"/>
<id root="4adc1020-7b14-11db-9fe1-0800200c9a66"/>
<code code="416098002" displayName="drug allergy" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20110215"/>
</effectiveTime>
<value xsi:type="CD" code="282100009" displayName="Adverse reaction to substance" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT">
<originalText>
<reference value="#reaction2"/>
</originalText>
</value>
<participant typeCode="CSM">
<participantRole classCode="MANU">
<playingEntity classCode="MMAT">
<code code="R16CO5Y76E" displayName="ASPIRIN" codeSystem="2.16.840.1.113883.4.9" codeSystemName="UNII">
<originalText>
<reference value="#reaction2"/>
</originalText>
</code>
<name>Aspirin</name>
</playingEntity>
</participantRole>
</participant>
<entryRelationship typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.28"/>
<!-- Alert status observation template -->
<code code="33999-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Status"/>
<statusCode code="completed"/>
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<!--
********************************************************
MEDICATIONS
********************************************************
-->
<component>
<section>
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<code code="10160-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="HISTORY OF MEDICATION USE"/>
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<text>
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<th>Directions</th>
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<td>Generic Substitition Allowed</td>
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</table>
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<reference value="#Med1"/> 0.09 MG/ACTUAT inhalant solution, 2 puffs QID PRN wheezing
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<!--
********************************************************
PROBLEM LIST
********************************************************
-->
<component>
<section>
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<code code="11450-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="PROBLEM LIST"/>
<title>Problems</title>
<text>
<list listType="ordered">
<item>Pneumonia: Resolved in March 1998</item>
<item>...</item>
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<entry typeCode="DRIV">
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<!-- Problem act template -->
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<!-- Problem status observation template -->
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<!-- Age observation template -->
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<!-- Health status observation template -->
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<!--
********************************************************
PROCEDURES
********************************************************
-->
<component>
<section>
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<!-- Procedures section template -->
<code code="47519-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="PROCEDURES"/>
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<thead>
<tr>
<th>Procedure</th>
<th>Date</th>
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<tbody>
<tr>
<td>
<content ID="Proc1">Colonic polypectomy</content>
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<td>1998</td>
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</tbody>
</table>
</text>
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<!-- ***** Procedure Activity Procedure Template ***** -->
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<!--
********************************************************
RESULTS
********************************************************
-->
<component>
<section>
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<code code="30954-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="RESULTS"/>
<title>Results</title>
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<table>
<tbody>
<tr>
<td colspan="2">LABORATORY INFORMATION</td>
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<tr>
<td colspan="2">Chemistries and drug levels</td>
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<tr>
<td>
<content ID="result1">HGB (M 13-18 g/dl; F 12-16 g/dl)</content>
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<td>13.2</td>
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<tr>
<td>
<content ID="result2">WBC (4.3-10.8 10+3/ul)</content>
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<td>6.7</td>
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<tr>
<td>
<content ID="result3">PLT (135-145 meq/l)</content>
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<td>123 (L)</td>
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<tr>
<td colspan="2">Liver Functions and Other Laboratory Values</td>
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<tr>
<td>ALT (SGPT)</td>
<td>31.0</td>
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<tr>
<td>AST (SGOT)</td>
<td>18.0</td>
</tr>
<tr>
<td>GGT</td>
<td>28.0 Alk</td>
</tr>
<tr>
<td>Phos</td>
<td>86.0</td>
</tr>
<tr>
<td>Total Bili</td>
<td>0.1</td>
</tr>
<tr>
<td>Albumin</td>
<td>3.2</td>
</tr>
<tr>
<td colspan="2">Blood Count</td>
</tr>
<tr>
<td>White Count</td>
<td>7.7</td>
</tr>
<tr>
<td>Platelets</td>
<td>187.0</td>
</tr>
<tr>
<td>Hematocrit</td>
<td>23.7</td>
</tr>
<tr>
<td>Hemoglobin</td>
<td>8.1</td>
</tr>
<tr>
<td colspan="2">ELECTROCARDIOGRAM (EKG) INFORMATION</td>
</tr>
<tr>
<td>EKG</td>
<td>Sinus rhythm without acute changes</td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<organizer classCode="BATTERY" moodCode="EVN">
<!-- Result organizer template -->
<templateId root="2.16.840.1.113883.10.20.22.4.1"/>
<id root="7d5a02b0-67a4-11db-bd13-0800200c9a66"/>
<code code="43789009" displayName="CBC WO DIFFERENTIAL" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"/>
<statusCode code="completed"/>
<component>
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<!-- Result observation template -->
<templateId root="2.16.840.1.113883.10.20.22.4.2"/>
<id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
<code code="30313-1" displayName="HGB" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC">
<originalText>
<reference value="#result1"/>
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<statusCode code="completed"/>
<effectiveTime value="200003231430"/>
<value xsi:type="PQ" value="13.2" unit="g/dl"/>
<interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83"/>
<methodCode/>
<targetSiteCode/>
<author>
<time/>
<assignedAuthor>
<id/>
</assignedAuthor>
</author>
<referenceRange>
<observationRange>
<text>M 13-18 g/dl; F 12-16 g/dl</text>
</observationRange>
</referenceRange>
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<!-- Result observation template -->
<templateId root="2.16.840.1.113883.10.20.22.4.2"/>
<id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
<code code="33765-9" displayName="WBC" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC">
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<reference value="#result2"/>
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</code>
<statusCode code="completed"/>
<effectiveTime value="200003231430"/>
<value xsi:type="PQ" value="6.7" unit="10+3/ul"/>
<interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83"/>
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<targetSiteCode/>
<author>
<time/>
<assignedAuthor>
<id/>
</assignedAuthor>
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<referenceRange>
<observationRange>
<value xsi:type="IVL_PQ">
<low value="4.3" unit="10+3/ul"/>
<high value="10.8" unit="10+3/ul"/>
</value>
</observationRange>
</referenceRange>
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<!-- Result observation template -->
<templateId root="2.16.840.1.113883.10.20.22.4.2"/>
<id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
<code code="26515-7" displayName="PLT" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC">
<originalText>
<reference value="#result3"/>
</originalText>
</code>
<statusCode code="completed"/>
<effectiveTime value="200003231430"/>
<value xsi:type="PQ" value="123" unit="10+3/ul"/>
<interpretationCode code="L" codeSystem="2.16.840.1.113883.5.83"/>
<methodCode/>
<targetSiteCode/>
<author>
<time/>
<assignedAuthor>
<id/>
</assignedAuthor>
</author>
<referenceRange>
<observationRange>
<value xsi:type="IVL_PQ">
<low value="150" unit="10+3/ul"/>
<high value="350" unit="10+3/ul"/>
</value>
</observationRange>
</referenceRange>
</observation>
</component>
</organizer>
</entry>
</section>
</component>
<!--
********************************************************
ADVANCE DIRECTIVES
********************************************************
-->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.21.1"/>
<title>Advance Directives</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Directive</th>
<th>Description</th>
<th>Verification</th>
<th>Supporting Document(s)</th>
</tr>
</thead>
<tbody>
<tr>
<td>Resuscitation status</td>
<td>
<content ID="AD1">Do not resuscitate</content>
</td>
<td>Dr. Robert Dolin, Nov 07, 1999</td>
<td>
<linkHtml href="AdvanceDirective.b50b7910-7ffb-4f4c-bbe4-177ed68cbbf3.pdf">Advance directive</linkHtml>
</td>
</tr>
</tbody>
</table>
</text>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.48"/>
<!-- ** Advance Directive Observation ** -->
<id root="9b54c3c9-1673-49c7-aef9-b037ed72ed27"/>
<code code="304251008" codeSystem="2.16.840.1.113883.6.96" displayName="Resuscitation"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20110213"/>
<high nullFlavor="NA"/>
</effectiveTime>
<value xsi:type="CD" code="304253006" codeSystem="2.16.840.1.113883.6.96" displayName="Do not resuscitate">
<originalText>
<reference value="#AD1"/>
</originalText>
</value>
<participant typeCode="VRF">
<templateId root="2.16.840.1.113883.10.20.1.58"/>
<time value="201102013"/>
<participantRole>
<id root="20cf14fb-b65c-4c8c-a54d-b0cca834c18c"/>
<playingEntity>
<name>
<prefix>Dr.</prefix>
<family>Dolin</family>
<given>Robert</given>
</name>
</playingEntity>
</participantRole>
</participant>
<participant typeCode="CST">
<participantRole classCode="AGNT">
<addr>
<streetAddressLine>21 North Ave.</streetAddressLine>
<city>Burlington</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>USA</country>
</addr>
<telecom value="tel:(555)555-1003"/>
<playingEntity>
<name>
<prefix>Dr.</prefix>
<family>Dolin</family>
<given>Robert</given>
</name>
</playingEntity>
</participantRole>
</participant>
<reference typeCode="REFR">
<seperatableInd value="false"/>
<externalDocument>
<id root="b50b7910-7ffb-4f4c-bbe4-177ed68cbbf3"/>
<text mediaType="application/pdf">
<reference value="AdvanceDirective.b50b7910-7ffb-4f4c-bbe4-177ed68cbbf3.pdf"/>
</text>
</externalDocument>
</reference>
</observation>
</entry>
</section>
</component>
<!--
********************************************************
ENCOUNTERS
********************************************************
-->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.22.1"/>
<!-- Encounters Section - required entries -->
<code code="46240-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of encounters"/>
<title>Encounters</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Encounter</th>
<th>Performer</th>
<th>Location</th>
<th>Date</th>
</tr>
</thead>
<tbody>
<tr>
<td>
<content ID="Encounter1"/> Examination</td>
<td>Performer Name</td>
<td>Good Health Clinic</td>
<td>Apr 07, 2000</td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<encounter classCode="ENC" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.49"/>
<!-- Encounter Activities -->
<!-- ******** Encounter activity template ******** -->
<id root="2a620155-9d11-439e-92b3-5d9815ff4de8"/>
<code code="99241" displayName="Office consultation - 15 minutes" codeSystemName="CPT" codeSystem="2.16.840.1.113883.6.12" codeSystemVersion="4">
<originalText>Checkup Examination<reference value="#Encounter1"/>
</originalText>
<translation code="AMB" codeSystem="2.16.840.1.113883.5.4" displayName="Ambulatory" codeSystemName="HL7 ActEncounterCode"/>
</code>
<effectiveTime value="20000407"/>
<performer>
<assignedEntity>
<id/>
<code code="59058001" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="General Physician"/>
</assignedEntity>
</performer>
<participant typeCode="LOC">
<participantRole classCode="SDLOC">
<templateId root="2.16.840.1.113883.10.20.22.4.32"/>
<!-- Service Delivery Location template -->
<code code="GACH" codeSystem="2.16.840.1.113883.5.111" codeSystemName="HL7 RoleCode" displayName="General Acute Care Hospital"/>
<addr>
<streetAddressLine>17 Daws Rd.</streetAddressLine>
<city>Blue Bell</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>US</country>
</addr>
<telecom nullFlavor="UNK"/>
<playingEntity classCode="PLC">
<name>Good Health Clinic</name>
</playingEntity>
</participantRole>
</participant>
<entryRelationship typeCode="RSON">
<observation classCode="COND" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.19"/>
<id root="db734647-fc99-424c-a864-7e3cda82e703" extension="45665"/>
<code code="404684003" displayName="Finding" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"/>
<statusCode code="completed"/>
<value xsi:type="CE" code="32398004" displayName="Bronchitis" codeSystem="2.16.840.1.113883.6.96"/>
</observation>
</entryRelationship>
</encounter>
</entry>
</section>
</component>
<!--
********************************************************
FAMILY HISTORY
********************************************************
-->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.15"/>
<!-- ******** Family history section template ******** -->
<code code="10157-6" codeSystem="2.16.840.1.113883.6.1"/>
<title>Family history</title>
<text>
<paragraph>Father (deceased)</paragraph>
<table border="1" width="100%">
<thead>
<tr>
<th>Diagnosis</th>
<th>Age At Onset</th>
</tr>
</thead>
<tbody>
<tr>
<td>Myocardial Infarction (cause of death)</td>
<td>57</td>
</tr>
<tr>
<td>Diabetes</td>
<td>40</td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<organizer moodCode="EVN" classCode="CLUSTER">
<templateId root="2.16.840.1.113883.10.20.22.4.45"/>
<!-- ******** Family history organizer template ******** -->
<statusCode code="completed"/>
<subject>
<relatedSubject classCode="PRS">
<code code="FTH" displayName="Father" codeSystemName="HL7 FamilyMember" codeSystem="2.16.840.1.113883.5.111">
<translation code="9947008" displayName="Biological father" codeSystemName="SNOMED" codeSystem="2.16.840.1.113883.6.96"/>
</code>
<subject>
<administrativeGenderCode code="M" codeSystem="2.16.840.1.113883.5.1" displayName="Male"/>
<birthTime value="1912"/>
</subject>
</relatedSubject>
</subject>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.46"/>
<!-- Family History Observation template -->
<id root="d42ebf70-5c89-11db-b0de-0800200c9a66"/>
<code code="55561003" displayName="Active" codeSystemName="SNOMED CT" codeSystem="2.16.840.1.113883.6.96"/>
<statusCode code="completed"/>
<effectiveTime nullFlavor="UNK"/>
<value xsi:type="CD" code="22298006" codeSystem="2.16.840.1.113883.6.96" displayName="Myocardial infarction"/>
<entryRelationship typeCode="CAUS">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.47"/>
<!-- ******** Family history death observation template ******** -->
<id root="6898fae0-5c8a-11db-b0de-0800200c9a66"/>
<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/>
<statusCode code="completed"/>
<value xsi:type="CD" code="419099009" codeSystem="2.16.840.1.113883.6.96" displayName="Dead"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.31"/>
<!-- ******** Age observation template ******** -->
<code code="397659008" codeSystem="2.16.840.1.113883.6.96" displayName="Age"/>
<statusCode code="completed"/>
<value xsi:type="PQ" value="57" unit="a"/>
</observation>
</entryRelationship>
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.46"/>
<!-- ******** Family history observation template ******** -->
<id root="5bfe3ec0-5c8b-11db-b0de-0800200c9a66"/>
<code code="7087005" displayName="Intermittent" codeSystemName="SNOMED CT" codeSystem="2.16.840.1.113883.6.96"/>
<statusCode code="completed"/>
<effectiveTime value="1994"/>
<value xsi:type="CD" code="46635009" codeSystem="2.16.840.1.113883.6.96" displayName="Diabetes mellitus type 1"/>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.31"/>
<!-- ******** Age observation template ******** -->
<code code="397659008" codeSystem="2.16.840.1.113883.6.96" displayName="Age"/>
<statusCode code="completed"/>
<value xsi:type="PQ" value="40" unit="a"/>
</observation>
</entryRelationship>
</observation>
</component>
</organizer>
</entry>
</section>
</component>
<!--
********************************************************
IMMUNIZATIONS
********************************************************
-->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.2"/>
<!-- ******** Immunizations section template ******** -->
<code code="11369-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of immunizations"/>
<title>Immunizations</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Vaccine</th>
<th>Date</th>
<th>Status</th>
</tr>
</thead>
<tbody>
<tr>
<td>
<content ID="immun1"/>Influenza virus vaccine, IM</td>
<td>Nov 1999</td>
<td>Completed</td>
</tr>
<tr>
<td>
<content ID="immun2"/>Influenza virus vaccine, IM</td>
<td>Dec 1998</td>
<td>Completed</td>
</tr>
<tr>
<td>
<content ID="immun3"/>Pneumococcal polysaccharide vaccine, IM</td>
<td>Dec 1998</td>
<td>Completed</td>
</tr>
<tr>
<td>
<content ID="immun4"/>Tetanus and diphtheria toxoids, IM</td>
<td>1997</td>
<td>Refused</td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false">
<templateId root="2.16.840.1.113883.10.20.22.4.52"/>
<!-- ******** Immunization activity template ******** -->
<id root="e6f1ba43-c0ed-4b9b-9f12-f435d8ad8f92"/>
<text>
<reference value="#immun1"/>
</text>
<statusCode code="completed"/>
<effectiveTime xsi:type="IVL_TS" value="199911"/>
<routeCode code="IM" codeSystem="2.16.840.1.113883.5.112" codeSystemName="RouteOfAdministration" displayName="Intramuscular injection"/>
<doseQuantity nullFlavor="UNK"/>
<consumable>
<manufacturedProduct>
<templateId root="2.16.840.1.113883.10.20.22.4.54"/>
<!-- ******** Immunization Medication Information ******** -->
<manufacturedMaterial>
<code code="88" codeSystem="2.16.840.1.113883.6.59" displayName="Influenza virus vaccine" codeSystemName="CVX">
<originalText>Influenza virus vaccine</originalText>
<translation code="111" displayName="influenza, live, intranasal" codeSystemName="CVX" codeSystem="2.16.840.1.113883.6.59"/>
</code>
</manufacturedMaterial>
</manufacturedProduct>
</consumable>
<entryRelationship typeCode="SUBJ">
<act classCode="ACT" moodCode="INT">
<templateId root="2.16.840.1.113883.10.20.22.4.20"/>
<!-- ** Instructions Template ** -->
<code code="171044003" codeSystem="2.16.840.1.113883.6.96" displayName="immunization education"/>
<text>Possible flu-like symptoms for three days.</text>
<statusCode code="completed"/>
</act>
</entryRelationship>
</substanceAdministration>
</entry>
<entry typeCode="DRIV">
<substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false">
<templateId root="2.16.840.1.113883.10.20.22.4.52"/>
<!-- ******** Immunization activity template ******** -->
<id root="e6f1ba43-c0ed-4b9b-9f12-f435d8ad8f92"/>
<text>
<reference value="#immun2"/>
</text>
<statusCode code="completed"/>
<effectiveTime xsi:type="IVL_TS" value="19981215"/>
<routeCode code="IM" codeSystem="2.16.840.1.113883.5.112" codeSystemName="RouteOfAdministration" displayName="Intramuscular injection"/>
<doseQuantity nullFlavor="UNK"/>
<consumable>
<manufacturedProduct>
<templateId root="2.16.840.1.113883.10.20.22.4.54"/>
<!-- ******** Immunization Medication Information ******** -->
<manufacturedMaterial>
<code code="88" codeSystem="2.16.840.1.113883.6.59" displayName="Influenza virus vaccine" codeSystemName="CVX">
<originalText>Influenza virus vaccine</originalText>
<translation code="111" displayName="influenza, live, intranasal" codeSystemName="CVX" codeSystem="2.16.840.1.113883.6.59"/>
</code>
</manufacturedMaterial>
</manufacturedProduct>
</consumable>
<entryRelationship typeCode="SUBJ">
<act classCode="ACT" moodCode="INT">
<templateId root="2.16.840.1.113883.10.20.22.4.20"/>
<!-- ** Instructions Template ** -->
<code code="171044003" codeSystem="2.16.840.1.113883.6.96" displayName="immunization education"/>
<text>Possible flu-like symptoms for three days.</text>
<statusCode code="completed"/>
</act>
</entryRelationship>
</substanceAdministration>
</entry>
<entry typeCode="DRIV">
<substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false">
<templateId root="2.16.840.1.113883.10.20.22.4.52"/>
<!-- ******** Immunization activity template ******** -->
<id root="e6f1ba43-c0ed-4b9b-9f12-f435d8ad8f92"/>
<text>
<reference value="#immun3"/>
</text>
<statusCode code="completed"/>
<effectiveTime xsi:type="IVL_TS" value="19981215"/>
<routeCode code="IM" codeSystem="2.16.840.1.113883.5.112" codeSystemName="RouteOfAdministration" displayName="Intramuscular injection"/>
<doseQuantity nullFlavor="UNK"/>
<consumable>
<manufacturedProduct>
<templateId root="2.16.840.1.113883.10.20.22.4.54"/>
<!-- ******** Immunization Medication Information ******** -->
<manufacturedMaterial>
<code code="33" codeSystem="2.16.840.1.113883.6.59" displayName="Pneumococcal polysaccharide vaccine" codeSystemName="CVX">
<originalText>Influenza virus vaccine</originalText>
<translation code="109" displayName="Pneumococcal NOS" codeSystemName="CVX" codeSystem="2.16.840.1.113883.6.59"/>
</code>
</manufacturedMaterial>
</manufacturedProduct>
</consumable>
<entryRelationship typeCode="SUBJ">
<act classCode="ACT" moodCode="INT">
<templateId root="2.16.840.1.113883.10.20.22.4.20"/>
<!-- ** Instructions Template ** -->
<code code="171044003" codeSystem="2.16.840.1.113883.6.96" displayName="immunization education"/>
<text>Possible flu-like symptoms for three days.</text>
<statusCode code="completed"/>
</act>
</entryRelationship>
</substanceAdministration>
</entry>
<entry typeCode="DRIV">
<substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false">
<templateId root="2.16.840.1.113883.10.20.22.4.52"/>
<!-- ******** Immunization activity template ******** -->
<id root="e6f1ba43-c0ed-4b9b-9f12-f435d8ad8f92"/>
<text>
<reference value="#immun3"/>
</text>
<statusCode code="completed"/>
<effectiveTime xsi:type="IVL_TS" value="19981215"/>
<routeCode code="IM" codeSystem="2.16.840.1.113883.5.112" codeSystemName="RouteOfAdministration" displayName="Intramuscular injection"/>
<doseQuantity nullFlavor="UNK"/>
<consumable>
<manufacturedProduct>
<templateId root="2.16.840.1.113883.10.20.22.4.54"/>
<!-- ******** Immunization Medication Information ******** -->
<manufacturedMaterial>
<code code="103" codeSystem="2.16.840.1.113883.6.59" displayName="Tetanus and diphtheria toxoids - preservative free" codeSystemName="CVX">
<originalText>Tetanus and diphtheria toxoids - preservative free</originalText>
<translation code="09" displayName="Tetanus and diphtheria toxoids - preservative free" codeSystemName="CVX" codeSystem="2.16.840.1.113883.6.59"/>
</code>
</manufacturedMaterial>
</manufacturedProduct>
</consumable>
<entryRelationship typeCode="SUBJ">
<act classCode="ACT" moodCode="INT">
<templateId root="2.16.840.1.113883.10.20.22.4.20"/>
<!-- ** Instructions Template ** -->
<code code="171044003" codeSystem="2.16.840.1.113883.6.96" displayName="immunization education"/>
<text>Possible flu-like symptoms for three days.</text>
<statusCode code="completed"/>
</act>
</entryRelationship>
<entryRelationship typeCode="RSON">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.53"/>
<!-- Immunization Refusal -->
<id/>
<code displayName="Patient Objection" code="PATOBJ" codeSystemName="HL7 ActNoImmunizationReason" codeSystem="2.16.840.1.113883.11.19725"/>
<statusCode code="completed"/>
</observation>
</entryRelationship>
</substanceAdministration>
</entry>
</section>
</component>
<!--
********************************************************
MEDICAL EQUIPMENT
********************************************************
-->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.23"/>
<!-- *** Medical equipment section template *** -->
<code code="46264-8" codeSystem="2.16.840.1.113883.6.1"/>
<title>Medical Equipment</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Supply/Device</th>
<th>Date Supplied</th>
</tr>
</thead>
<tbody>
<tr>
<td>Automatic implantable cardioverter/defibrillator</td>
<td>Nov 1999</td>
</tr>
<tr>
<td>Total hip replacement prosthesis</td>
<td>1998</td>
</tr>
<tr>
<td>Wheelchair</td>
<td>1999</td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<supply classCode="SPLY" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.50"/>
<!-- Non-medicinal supply activity template ******* -->
<id root="2413773c-2372-4299-bbe6-5b0f60664446"/>
<statusCode code="completed"/>
<effectiveTime xsi:type="IVL_TS">
<high value="199911"/>
</effectiveTime>
<quantity value="2"/>
<participant typeCode="PRD">
<participantRole classCode="MANU">
<templateId root="2.16.840.1.113883.10.20.22.4.37"/>
<!-- ******** Product instance template ******** -->
<playingDevice>
<code code="72506001" codeSystem="2.16.840.1.113883.6.96" displayName="Automatic implantable cardioverter/defibrillator"/>
</playingDevice>
<scopingEntity>
<id root="eb936010-7b17-11db-9fe1-0800200c9b65"/>
</scopingEntity>
</participantRole>
</participant>
</supply>
</entry>
<entry typeCode="DRIV">
<supply classCode="SPLY" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.50"/>
<!-- ******** Non-medicinal supply activity template ******** -->
<id root="230b0ab7-206d-42d8-a947-ab4f63aad795"/>
<statusCode code="completed"/>
<effectiveTime xsi:type="IVL_TS">
<center value="1998"/>
</effectiveTime>
<participant typeCode="DEV">
<participantRole classCode="MANU">
<templateId root="2.16.840.1.113883.10.20.22.4.37"/>
<!-- ******** Product instance template ******** -->
<id root="03ca01b0-7be1-11db-9fe1-0800200c9a66"/>
<addr/>
<telecom/>
<playingDevice>
<code code="304120007" codeSystem="2.16.840.1.113883.6.96" displayName="Total hip replacement prosthesis"/>
</playingDevice>
<scopingEntity>
<id root="0abea950-5b40-4b7e-b8d9-2a5ea3ac5500"/>
<desc>Good Health Prostheses Company</desc>
</scopingEntity>
</participantRole>
</participant>
</supply>
</entry>
<entry typeCode="DRIV">
<supply classCode="SPLY" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.50"/>
<!-- ******** Non-medicinal supply activity template ******** -->
<id root="c4ffe98e-3cd3-4c54-b5bd-08ecb80379e0"/>
<statusCode code="completed"/>
<effectiveTime xsi:type="IVL_TS">
<center value="1999"/>
</effectiveTime>
<participant typeCode="DEV">
<participantRole classCode="MANU">
<templateId root="2.16.840.1.113883.10.20.22.4.37"/>
<!-- ******** Product instance template ******** -->
<addr/>
<telecom/>
<playingDevice>
<code code="58938008" codeSystem="2.16.840.1.113883.6.96" displayName="Wheelchair"/>
</playingDevice>
<scopingEntity>
<id root="eb936010-7b17-11db-9fe1-0800200c9b67"/>
</scopingEntity>
</participantRole>
</participant>
</supply>
</entry>
</section>
</component>
<!--
********************************************************
PAYERS
********************************************************
-->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.18"/>
<!-- ******** Payers section template ******** -->
<code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payments"/>
<title>Insurance Providers</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Payer name</th>
<th>Policy type / Coverage type</th>
<th>Policy ID</th>
<th>Covered party ID</th>
<th>Policy Holder</th>
</tr>
</thead>
<tbody>
<tr>
<td>Good Health Insurance</td>
<td>Extended healthcare / Family</td>
<td>Contract Number</td>
<td>1138345</td>
<td>Patient's Mother</td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<act classCode="ACT" moodCode="DEF">
<templateId root="2.16.840.1.113883.10.20.22.60"/>
<!-- ******** Coverage entry template ******** -->
<id root="1fe2cdd0-7aad-11db-9fe1-0800200c9a66"/>
<code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment sources"/>
<statusCode code="completed"/>
<entryRelationship typeCode="COMP">
<act classCode="ACT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.61"/>
<!-- ******** Policy Activity template ******** -->
<id root="3e676a50-7aac-11db-9fe1-0800200c9a66"/>
<code code="SELF" codeSystemName="HL7 RoleClassRelationship" codeSystem="2.16.840.1.113883.5.110">
</code>
<statusCode code="completed"/>
<!-- Insurance Company Information -->
<performer typeCode="PRF">
<time/>
<assignedEntity>
<id root="2.16.840.1.113883.19"/>
<code code="PAYOR" codeSystem="2.16.840.1.113883.5.110" codeSystemName="HL7 RoleClassRelationship"/>
<addr use="WP">
<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
<streetAddressLine>123 Insurance Road</streetAddressLine>
<city>Blue Bell</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>US</country>
<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
</addr>
<telecom value="tel:(781)555-1515" use="WP"/>
<representedOrganization>
<name>Good Health Insurance</name>
<telecom/>
<addr/>
</representedOrganization>
</assignedEntity>
</performer>
<!-- Guarantor Information.... The person responsible for the final bill. -->
<performer typeCode="PRF">
<time/>
<assignedEntity>
<id root="329fcdf0-7ab3-11db-9fe1-0800200c9a66"/>
<code code="GUAR" codeSystem="2.16.840.1.113883.5.110" codeSystemName="HL7 RoleClassRelationship"/>
<addr use="HP">
<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
<streetAddressLine>17 Daws Rd.</streetAddressLine>
<city>Blue Bell</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>US</country>
<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
</addr>
<telecom value="tel:(781)555-1212" use="HP"/>
<assignedPerson>
<name>
<prefix>Mr.</prefix>
<given>Adam</given>
<given>Frankie</given>
<family>Everyman</family>
</name>
</assignedPerson>
</assignedEntity>
</performer>
<participant typeCode="COV">
<time>
<low nullFlavor="UNK"/>
<high nullFlavor="UNK"/>
</time>
<participantRole classCode="PAT">
<id root="14d4a520-7aae-11db-9fe1-0800200c9a66" extension="1138345"/>
<!-- Health plan ID for patient. -->
<code code="SELF" codeSystem="2.16.840.1.113883.5.111" displayName="Self"/>
<addr use="HP">
<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
<streetAddressLine>17 Daws Rd.</streetAddressLine>
<city>Blue Bell</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>US</country>
<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
</addr>
<playingEntity>
<name>
<!-- Name is needed if different than health plan name. -->
<prefix>Mr.</prefix>
<given>Frank</given>
<given>A.</given>
<family>Everyman</family>
</name>
</playingEntity>
</participantRole>
</participant>
<participant typeCode="HLD">
<participantRole>
<id extension="1138345" root="2.16.840.1.113883.19"/>
<addr use="HP">
<streetAddressLine>17 Daws Rd.</streetAddressLine>
<city>Blue Bell</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>US</country>
</addr>
</participantRole>
</participant>
<entryRelationship typeCode="REFR">
<act classCode="ACT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.1.19"/>
<!-- ******** Authorization activity template ******** -->
<id root="f4dce790-8328-11db-9fe1-0800200c9a66"/>
<code nullFlavor="NA"/>
<entryRelationship typeCode="SUBJ">
<procedure classCode="PROC" moodCode="PRMS">
<code code="73761001" codeSystem="2.16.840.1.113883.6.96" displayName="Colonoscopy"/>
</procedure>
</entryRelationship>
</act>
</entryRelationship>
<!-- The above entryRelationship OR the following.
<entryRelationship typeCode="REFR">
<act classCode="ACT" moodCode="DEF">
<id root="f4dce790-8328-11db-9fe1-0800200c9a66"/>
<code nullFlavor="UNK"/>
<text>Health Plan Name<reference value="PntrToHealthPlanNameInSectionText"/>
</text>
<statusCode code="active"/>
</act>
</entryRelationship>
-->
</act>
</entryRelationship>
</act>
</entry>
</section>
</component>
<!--
********************************************************
PLAN OF CARE
********************************************************
-->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.10"/>
<!-- **** Plan of Care section template **** -->
<code code="18776-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Treatment plan"/>
<title>Plan of Care</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Planned Activity</th>
<th>Planned Date</th>
</tr>
</thead>
<tbody>
<tr>
<td>Colonoscopy</td>
<td>April 21, 2000</td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<observation classCode="OBS" moodCode="RQO">
<templateId root="2.16.840.1.113883.10.20.22.4.44"/>
<!-- Plan of Care Activity Observation template -->
<id root="9a6d1bac-17d3-4195-89a4-1121bc809b4a"/>
<code code="310634005" codeSystem="2.16.840.1.113883.6.96" displayName="Colonoscopy"/>
<statusCode code="new"/>
<effectiveTime>
<center value="20000421"/>
</effectiveTime>
</observation>
</entry>
<entry>
<act moodCode="RQO" classCode="ACT">
<templateId root="2.16.840.1.113883.10.20.22.4.39"/>
<!-- **** Plan of Care Activity Act template **** -->
<id root="9a6d1bac-17d3-4195-89a4-1121bc809a5c"/>
<code code="310634005" codeSystem="2.16.840.1.113883.6.96" displayName="Colonoscopy"/>
<statusCode code="new"/>
<effectiveTime>
<center value="20000421"/>
</effectiveTime>
</act>
</entry>
<entry>
<encounter moodCode="INT" classCode="ENC">
<templateId root="2.16.840.1.113883.10.20.22.4.40"/>
<!-- **** Plan of Care Activity Encounter template **** -->
<id root="9a6d1bac-17d3-4195-89a4-1121bc809b4d"/>
</encounter>
</entry>
<entry>
<procedure moodCode="RQO" classCode="PROC">
<templateId root="2.16.840.1.113883.10.20.22.4.41"/>
<!-- ** Plan of Care Activity Procedure template ** -->
<id root="9a6d1bac-17d3-4195-89c4-1121bc809b5a"/>
<code code="310634005" codeSystem="2.16.840.1.113883.6.96" displayName="Colonoscopy"/>
<statusCode code="new"/>
<effectiveTime>
<center value="20000421"/>
</effectiveTime>
</procedure>
</entry>
</section>
</component>
<!--
********************************************************
SOCIAL HISTORY
********************************************************
-->
<component>
<!-- Social History ******** -->
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.17"/>
<!-- ******** Social history section template ******** -->
<code code="29762-2" codeSystem="2.16.840.1.113883.6.1" displayName="Social History"/>
<title>Social History</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Social History Element</th>
<th>Description</th>
<th>Effective Dates</th>
</tr>
</thead>
<tbody>
<tr>
<td>
<content ID="soc1"/> smoking</td>
<td>1 pack per day</td>
<td>1947 - 1972</td>
</tr>
<tr>
<td>
<content ID="soc2"/> smoking</td>
<td>None</td>
<td>1973 - </td>
</tr>
<tr>
<td>
<content ID="soc3"/>Alcohol consumption</td>
<td>None</td>
<td>1973 - </td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.38"/>
<!-- ******** Social history observation template ******** -->
<id root="9b56c25d-9104-45ee-9fa4-e0f3afaa01c1"/>
<code code="230056004" codeSystem="2.16.840.1.113883.6.96" displayName="Cigarette smoking">
<originalText>
<reference value="#soc1"/>
</originalText>
</code>
<statusCode code="completed"/>
<effectiveTime>
<low value="1947"/>
<high value="1972"/>
</effectiveTime>
<value xsi:type="ST">1 pack per day</value>
</observation>
</entry>
<entry typeCode="DRIV">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.38"/>
<!-- ******** Social history observation template ******** -->
<id root="45efb604-7049-4a2e-ad33-d38556c9636c"/>
<code code="230056004" codeSystem="2.16.840.1.113883.6.96" displayName="Cigarette smoking">
<originalText>
<reference value="#soc2"/>
</originalText>
</code>
<statusCode code="completed"/>
<effectiveTime>
<low value="1973"/>
</effectiveTime>
<value xsi:type="ST">None</value>
</observation>
</entry>
<entry typeCode="DRIV">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.38"/>
<!-- ******** Social history observation template ******** -->
<id root="37f76c51-6411-4e1d-8a37-957fd49d2cef"/>
<code code="160573003" codeSystem="2.16.840.1.113883.6.96" displayName="Alcohol consumption">
<originalText>
<reference value="#soc3"/>
</originalText>
</code>
<statusCode code="completed"/>
<effectiveTime>
<low value="1973"/>
</effectiveTime>
<value xsi:type="ST">None</value>
</observation>
</entry>
</section>
</component>
<!--
********************************************************
VITAL SIGNS
********************************************************
-->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.4.1"/>
<code code="8716-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="VITAL SIGNS"/>
<title>Vital Signs</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th align="right">Date / Time: </th>
<th>Nov 14, 1999</th>
<th>April 7, 2000</th>
</tr>
</thead>
<tbody>
<tr>
<th align="left">Height</th>
<td>
<content ID="vit1">177 cm</content>
</td>
<td>
<content ID="vit2">177 cm</content>
</td>
</tr>
<tr>
<th align="left">Weight</th>
<td>
<content ID="vit3">86 kg</content>
</td>
<td>
<content ID="vit4">88 kg</content>
</td>
</tr>
<tr>
<th align="left">Blood Pressure</th>
<td>
<content ID="vit5">132/86 mmHg</content>
</td>
<td>
<content ID="vit6">145/88 mmHg</content>
</td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<organizer classCode="CLUSTER" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.26"/>
<!-- Vital signs organizer template -->
<id root="c6f88320-67ad-11db-bd13-0800200c9a66"/>
<code code="46680005" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED -CT" displayName="Vital signs"/>
<statusCode code="completed"/>
<effectiveTime value="19991114"/>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.27"/>
<!-- Vital Sign Observation template -->
<id root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code code="8302-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Height"/>
<text>
<reference value="#vit1"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="19991114"/>
<value xsi:type="PQ" value="177" unit="cm"/>
<interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83"/>
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.27"/>
<!-- Vital Sign Observation template -->
<id root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code code="3141-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Patient Body Weight - Measured"/>
<text>
<reference value="#vit4"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="19991114"/>
<value xsi:type="PQ" value="86" unit="kg"/>
<interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83"/>
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.27"/>
<!-- Vital Sign Observation template -->
<id root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code code="8480-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Intravascular Systolic"/>
<text>
<reference value="#vit5"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="19991114"/>
<value xsi:type="PQ" value="132" unit="mm[Hg]"/>
<interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83"/>
</observation>
</component>
</organizer>
</entry>
<entry typeCode="DRIV">
<organizer classCode="CLUSTER" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.26"/>
<!-- Vital signs organizer template -->
<id root="c6f88320-67ad-11db-bd13-0800200c9a66"/>
<code code="46680005" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED -CT" displayName="Vital signs"/>
<statusCode code="completed"/>
<effectiveTime value="20000407"/>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.27"/>
<!-- Vital Sign Observation template -->
<id root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code code="8302-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Height"/>
<text>
<reference value="#vit2"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20000407"/>
<value xsi:type="PQ" value="177" unit="cm"/>
<interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83"/>
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.27"/>
<!-- Vital Sign Observation template -->
<id root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code code="3141-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Patient Body Weight - Measured"/>
<text>
<reference value="#vit4"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20000407"/>
<value xsi:type="PQ" value="88" unit="kg"/>
<interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83"/>
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.27"/>
<!-- Vital Sign Observation template -->
<id root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code code="8480-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Intravascular Systolic"/>
<text>
<reference value="#vit6"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20000407"/>
<value xsi:type="PQ" value="145" unit="mm[Hg]"/>
<interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83"/>
</observation>
</component>
</organizer>
</entry>
</section>
</component>
<!--
**Required Sections
Allergies
Medications
Problem List
Procedures
Results
**Optional Sections
Advance Directives
Encounters
Family History
Functional Status
Immunizations
Medical Equipment
Payers
Plan of Care
Social History
Vital Signs
-->
</structuredBody>
</component>
</ClinicalDocument>
SampleCCDA.xml
Jayant Singh
(rajputjayant@gmail.com)Displaying SampleCCDA.xml.
Sample CCDA document JSON
with these sections only (Header, Allergies, Enconters, Immunizations, Results, Problems, Procedures & Medications {
"document": {
"effectiveTime": "20050329171504+0500",
"author": {
"name": {
"given": "Henry",
"family": "Seven"
},
"phone": {
"work": "tel:(555)555-1003"
},
"address": {
"street": "21 North Ave.",
"city": "Burlington",
"state": "MA",
"zip": "02368",
"country": "USA"
}
},
"documentationOf": {
"performers": [
{
"name": {
"prefix": "Dr.",
"given": "Pseudo",
"family": "Physician-1"
},
"address": {},
"phone": {
"work": "tel:+1-301-975-3251"
}
},
{
"name": {
"prefix": "Dr.",
"given": "Pseudo",
"family": "Physician-3"
},
"address": {},
"phone": {
"work": "tel:+1-301-975-3251"
}
}
]
},
"demographics": {
"name": {
"prefix": "Dr.",
"given": "Pseudo",
"family": "Physician-3"
},
"birthTime": "19541125",
"administrativeGenderCode": "M",
"maritalStatusCode": "M",
"address": {
"street": "17 Daws Rd.",
"city": "Blue Bell",
"state": "MA",
"zip": "02368",
"country": "US"
},
"phone": {
"home": "tel:(781)555-1212"
},
"language": "fr-CN",
"race": "White",
"ethnicity": "Not Hispanic or Latino",
"religion": "Christian (non-Catholic, non-specific)",
"birthplace": {
"state": "MA",
"zip": "02368",
"country": "USA"
},
"guardian": {
"relationship": "Grandfather",
"name": {
"given": "Ralph",
"family": "Relative"
},
"address": {
"state": "MA",
"zip": "02368",
"country": "USA"
}
},
"providerOrganization": {
"name": "Good Health Clinic",
"address": {
"street": "21 North Ave",
"city": "Burlington",
"state": "MA",
"zip": "02368",
"country": "USA"
}
}
},
"allergies": [
{
"effectiveTime": {
"end_date": "20100103",
"start_date": "20090902",
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